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General NPI Number Information
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NPI Number | 1184017808
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Entity Type | Individual
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Provider Name | MATTHEW DOUGLASS BALDWIN LMFT
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Gender | Male
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Dates
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Enumeration Date | 03/05/2015
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1706 FAIR OAKS AVE APT B
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-4731
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Country | US
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Telephone | 510-296-5682
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Fax |
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Provider Business Mailing Address
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Address Line | 1441 HUNTINGTON DR STE 2310
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-4512
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Country | US
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Telephone | 510-296-5682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 190632
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 109632
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License Number State | CA
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